Mortality estimates for years up to 2005 are based on Australian Bureau of Statistics death registration data. Data from 2006 onwards were provided by the Australian Coordinating Registry, Cause of Death Unit Record File; the data for the most 2 recent years are preliminary (SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health)
An underlying cause of death is often called a 'principal' cause and an associated cause 'contributing'. Diabetes-related deaths are those where diabetes is either the underlying cause of death or it is an associated cause of death, where the underlying cause is one of the commonly recognised complications of diabetes. Total deaths associated with diabetes include those with underlying causes not related to diabetes. Refer to Methods for more information. Only NSW residents are included. Deaths were classified using ICD-10. Rates were age-adjusted using the Australian population as at 30 June 2001.
Counts of deaths for the latest years of data include an estimate of the number of deaths occurring in that year but registered in the next year. Data on late registrations were unavailable at the time of production.LL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate.
The term 'diabetes-related death' is used in HealthStats NSW to refer to deaths where diabetes was recorded as the underlying cause of death, or where diabetes was recorded as an associated cause of death and the underlying cause of death was one of the commonly recognised diabetes complications. An underlying cause of death is often called a 'principal' cause and an associated cause 'contributing'. The common complications of diabetes included in the definition of diabetes-related deaths are: myocardial infarction, ischaemic heart disease, stroke or sequelae of stroke, heart failure, sudden death (cardiac arrest), peripheral vascular disease, kidney disease, hyperglycaemia and hypoglycaemia (Dixon et al. 2005).
The reason for defining diabetes deaths in this way is that, more than other disorders, diabetes often causes death indirectly as it is an important risk factor for common causes of death such as heart, kidney disease and stroke. These diseases are likely to appear as the underlying cause of death which is the basis for official mortality statistics. The inclusion of deaths from diabetes as the underlying cause only would lead to a considerable underestimation of the overall mortality burden caused by diabetes (Dixon et al. 2005).
This concept of 'diabetes-related deaths' is based on the definition of 'death related to diabetes' used in the United Kingdom Prospective Diabetes Study (UKPDS) since 1998. The UKPDS definition has been modified by diabetes specialists of the National Diabetes Data Working Group, associated with the Australian Institute of Health and Welfare (AIHW). The Group included additional conditions in the Australian definition. These conditions are: ischaemic heart disease, stroke or sequelae of stroke and heart failure (Dixon et al. 2005).
Refer to Understanding diabetes mortality in NSW on HealthStats Plus for further details; and Coding tab for the full list of codes of conditions used to define 'diabetes-related' deaths.
Dixon T, Webbie K. Diabetes-related deaths 2001-2003. Canberra: 2005. http://www.aihw.gov.au/publications/index.cfm/title/10221
In order to complete a death registration in Australia, the death must be certified by either a doctor using the Medical Certificate of Cause of Death, or by a coroner. Natural causes are predominantly certified by doctors, whereas External and Unknown causes or unaccompanied deaths are usually certified by a Coroner. Approximately 85-90% of deaths each year are certified by a doctor and the remainder is reported to a Coroner. The death is registered in the state in which the death occurred, rather than the state in which the person resides. The Australian Cause of Death Statistics System is outlined by the Australian Bureau of Statistics at http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/47E19CA15036B04BCA2577570014668B?opendocument.
The Australian Bureau of Statistics (ABS) have implemented a revision process for Coroner certified deaths. Data are deemed preliminary when published for the first time, revised when published the following year and final when published two years after initial publication. This revision process, and the impact on specific causes are described at http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12015?OpenDocument .
The Australian Bureau of Statistics publishes two publications every year: Deaths, Australia (Catalogue Number 3302.0) in November, eleven months after the end of the concerned year and Causes of death, Australia (Catalogue Number 3303.0), in March, fifteen months after the end of the year concerned.
The Australian Coordinating Registry (ACR) is an agency appointed coordinate access to coded cause of death unit record data on behalf of the Registrars of Births Deaths and Marriages in each state or territory as well as the Australian Bureau of Statistics and National Coronial Information System. The coordinating registry undertakes the coordination and management of the designated activity. The underlying legal responsibility is retained by the collective Registrars.
The ACR provides the NSW Ministry of Health with a national cause of death unit record file to allow detailed anaylsis of deaths data.
There is usually an interval between the occurrence and registration of a death which is related to the time of year or whether a death is refered to a Coroner. The registration of deaths which occur in November and December are likely to be delayed until the following year, for example, of all deaths in NSW registered in 2013, 6.9% occurred in 2012 or earlier (ABS 3302.0).
Deaths data reported by the ABS for the latest year are based on the year of registration therefore do not include deaths which occurred in that year but where registration was delayed. Deaths data reported in HealthStats NSW are based on the year of occurrence of the death. Estimates of missing deaths for the latest year due to delayed registration (ie due to time of year or Coronial cases) are imputed for each cause and included in the count for the reports in HealthStats NSW. A small percentage of death registrations may be delayed for more than one year. All deaths figures are updated historically (eg in trends) in this report when new data becomes available.
For the calculation of rates, the NSW Ministry of Health uses population projection estimates from the NSW Department of Planning and Environment. The estimated residential populations which are not projected are the same as those published by the ABS and are currently based on the 2016 Census. See Methods associated with indicators in topics Demography (or Population) for further discussion of population estimates.
Australian Bureau of Statistics. Deaths, Australia, latest year. 3302.0. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3302.0
Australian Bureau of Statistics. Causes of Deaths, Australia, latest year. 3303.0. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0
Australian Bureau of Statistics. Multiple Cause of Deaths, Australia, 1997-2001. 3319.0.55.001. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3319.0.55.001
|Description||ICD-10 & ICD-10-AM||Comments|
|Diabetes-related deaths (total underlying + selected associated)||Underlying cause E10-E14, or associated cause E10-E14 with underlying cause E16.1-E16.2, I20-I22, I24-I25, I46, I50, I60-I64, I69.0-I69.4, I70-I74, N01-N28, R73||All records are included, NSW residents only, all ages.|
|Diabetes-related deaths - Underlying cause (total)||Underlying cause E10-E14|
|Diabetes-related deaths - Associated cause (total)||Associated cause E10-E14|
|Diabetes-related deaths - Underlying cause (total) or Associated cause (total)||Underlying or associated cause E10-E14|
• 11.1% of adults aged 16 years and over (12.6% of men and 9.7% of women) had diabetes or high blood glucose as estimated from the 2018 NSW Adult Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI). It is likely that there are many people with diabetes in NSW who are unaware they have it.
• Prevalence estimates have been increasing over time.
• Diabetes prevalence increases with age and socioeconomic disadvantage and diabetes is more prevalent among Aboriginal people.
• In NSW between 2012-13 and 2018-19, the hospitalisation rate for diabetes as a principal diagnosis did not change substantially. In 2018-19, the rate of hospitalisation for diabetes as a principal diagnosis was 162.5 per 100,000 population (187.1 per 100,000 population for males and 141.5 per 100,000 population for females). In 2017-18, there was an average of 1.3 hospitalisations for diabetes per person in NSW.
• While Type 2 diabetes accounts for up to 90% of all diabetes cases in the community, it accounted for around 66% of all hospitalisations for diabetes in 2018-19. Type 1 diabetes accounted for around 27% of hospitalisations and gestational diabetes for around 6%.
• While diabetes was the principal (underlying) cause of around 3% of all deaths in NSW in 2017 (1,609 deaths), around 6% of all deaths in that year were directly related to diabetes (2,930 deaths) and 11% (5,922) involved diabetes in some way. Cardiovascular disease was the most common cause of death among people with diabetes.
As estimated from the 2017-18 National Health Survey: First Results, 4.9% of adults aged 18 years and over (5.5% of men and 4.3% of women) had diabetes.
Diabetes mellitus is a group of closely related chronic conditions characterised by high blood sugar (glucose) levels. In uncontrolled diabetes, glucose builds up in the bloodstream and leads to a range of short- and long-term problems, including damage to vital organs.
Diabetes and its associated complications contribute significantly, both directly and indirectly, to mortality, morbidity, poor quality of life of sufferers and carers and the cost of health care. Experts agree that diabetes now represents one of the most challenging public health problems of the 21st century worldwide (Tanamas et al. 2013). Diabetes and cardiovascular conditions together are the causes of about one-third of all years of life lost due to premature death and about one-fifth of all years lost to premature death or years lived with a disability in NSW. The contribution of diabetes to the total disease burden in Australia in 2011 was 2.3% (AIHW 2016).
There are three main forms of diabetes mellitus: Type 1 diabetes, Type 2 diabetes and gestational diabetes. Type 1 diabetes is estimated to be present in 10-15% of people with diabetes and is caused by a combination of genetic and environmental factors, but there are no known modifiable risk factors for this form of diabetes. Type 2 diabetes accounts for about 85-90% of all diabetes cases and primarily affects people older than 40 years. Several modifiable risk factors play a role in the onset of Type 2 diabetes, including obesity, physical inactivity and poor nutrition, as does genetic predisposition and ageing. Gestational diabetes mellitus occurs during pregnancy in about 3-8% of females not previously known to have diabetes. It is a temporary form of diabetes and usually resolves after the baby is born (Beers et al. 1999). The fourth, minor group, includes diabetes secondary to other conditions, for example diseases of the pancreas or drug-induced or chemical-induced diabetes.
Diabetes can lead to acute and chronic complications. Acute metabolic disturbances can lead to coma. Chronic high blood glucose levels (hyperglycaemia) are associated with long-term damage, dysfunction and failure of virtually every body organ, especially the heart and blood vessels, eyes, kidneys and nerves. Consequently, diabetes predisposes those suffering from it to many severe conditions, including cardiovascular disease, as well as visual loss, amputations and renal failure.
Sustained, individualised management substantially reduces the risk of complications in people with diabetes. A combination of diet, exercise and medication (including insulin injections) is used in combination with very frequent monitoring of blood glucose levels and other risk factors (for example blood lipids and blood pressure) and regular screening for complications.
In the past, Type 1 diabetes was called 'insulin-dependent diabetes mellitus' (IDDM) or 'juvenile-onset' and Type 2 diabetes was called 'non-insulin-dependent diabetes mellitus' (NIDDM). However, as insulin is often used to treat patients with Type 2 diabetes, the old terminology has been discouraged by the WHO since 2000 (NCCH Volume 5 2000).
Diabetes mellitus and diabetes insipidus are completely different conditions. Diabetes insipidus (DI, Central diabetes insipidus) is a temporary or chronic disorder that causes sufferers to excrete excessive quantities of otherwise normal urine and excessive thirst. Excessive urination and thirst are the features in common with diabetes mellitus , hence a Greek word for syphon (diabetes) is used in the name of both conditions. Diabetes insipidus is caused by deficiency of hormone called vasopressin (ADH) and is much less common than diabetes mellitus (Beers MH et al. 1999). This topic and data in the Report refer to diabetes mellitus.
Tanamas SK et al. The Australian diabetes, obesity and lifestyle study (AusDiab). Baker IDI Heart and Diabetes Institute, 2013.
Beers MH, Berkow R. The Merck manual of diagnosis and therapy. West Point: Merck & Co, 1999.
Australian Institute of Health and Welfare. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. BOD 4. Canberra: AIHW, 2016.
National Centre for Classification in Health. The International statistical classification of diseases and related health problems, 10th Revision, Australian Modification (ICD-10-AM). Volume 5. Sydney: NCCH, 2000.
The best way to reduce the harm caused by diabetes is by preventing the onset of Type 2 diabetes. Diabetes shares many modifiable risk factors with other lifestyle-related chronic diseases such as cardiovascular diseases. These include smoking, physical inactivity, poor diet, too much alcohol and being overweight. This means that strategies related to the prevention, early detection and optimal management of these risk factors will lead to better health outcomes for people with Type 2 diabetes and other lifestyle-related chronic diseases.
NSW Health provides support for the prevention and optimal management of Type 2 diabetes through a broad range of programs:
The NSW Healthy Eating and Active Living (HEAL) Strategy 2013-2018 provides a whole of government framework to promote and support healthy eating and active living in NSW and to reduce the impact of lifestyle-related chronic disease. Further information on the NSW HEAL strategy is available from http://www.health.nsw.gov.au/heal/Pages/default.aspx.
Get Healthy at Work is a new NSW Government initiative that aims to improve the health of working adults. It focuses on healthy weight, physical activity, healthy eating, active travel, smoking and harmful alcohol consumption. Further information on the NSW Get Healthy at Work initiative is available from http://www.health.nsw.gov.au/healthyworkers/pages/default.aspx
This free, confidential telephone-based coaching service supports NSW adults to make sustained improvements in healthy eating, physical activity, and achieving and maintaining a healthy weight. Further information on the Get Healthy Information and Coaching Service is available from http://www.gethealthynsw.com.au
This initiative is intended to support informed, healthier food choices in NSW. As of 1 February 2012, major food retailing outlets with 20 or more stores in NSW and more than 50 stores nationally are required to include information about the kilojoule (kj) content of standard products on their menu boards. The 8700 Find Your Ideal Figure website provides information, links, tips, online calculators and tools, including a mobile phone application. Further information is available from www.8700.com.au.
The built environment can play an important role in promoting and supporting healthy behaviours. Research demonstrates the link between the modern epidemic of lifestyle-related chronic diseases such as cardiovascular diseases and Type 2 diabetes, and the way we live in the built environment. Car-dominated transport, coupled with a lack of active transport options (walking, cycling and public transport), reduce opportunities for physical activity. Sprawling low-density residential developments with poor access to amenities including healthy, fresh food and poor connectivity can negatively impact on both mental and physical health.
The NSW Agency for Clinical Innovation established the Endocrine Network in 2007 to assist clinicians working with patients who have diabetes or obesity to develop best practice guidelines for treatment and to provide direction for diabetes and obesity research, education and management. The Endocrine Network has a number of priority areas including the development of the NSW Model of Care for Diabetes Mellitus covering the identification, treatment and management of people with Type 1 and 2 diabetes, gestational diabetes and diabetes in pregnancy. Further information on the Endocrine Network is available from http://www.aci.health.nsw.gov.au/networks/endocrine
The NSW Chronic Disease Management Program (CDMP) aims to deliver an integrated, patient focused, whole person approach to effective health management to improve the quality of life of people with chronic and complex conditions, their carers and families and to prevent unplanned and avoidable hospital admissions. It achieves this by coordinating a statewide chronic disease management approach. The CDMP focuses on the five major chronic diseases recognised as having a major impact on the burden of disease in NSW: diabetes, chronic obstructive pulmonary disease (mainly emphysema and chronic bronchitis), coronary artery disease (also known as coronary or ischaemic heart disease), hypertension (high blood pressure), and congestive heart failure. It is overseen by the Chronic Disease Management Office. Further information on the NSW Chronic Disease Management Program (Connecting Care in the Community) is available from http://www.health.nsw.gov.au/cdm/pages/default.aspx
The NSW Chronic Care for Aboriginal People (CCAP) Program is managed by the NSW Agency for Clinical Innovation. The aim of the CCAP is to prevent and manage conditions including diabetes, heart disease, stroke, hypertension and kidney disease among Aboriginal people. These conditions share common risk factors, and common approaches are needed to address them in Aboriginal communities. Further information on the NSW Chronic Care for Aboriginal People Program is available from https://www.aci.health.nsw.gov.au/networks/ccap
NSW Ministry of Health at www.health.nsw.gov.au
Diabetes Australia at http://www.diabetesaustralia.com.au/
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare and its National Centre for Monitoring Diabetes at http://www.aihw.gov.au
Australian Diabetes Society and its National Association of Diabetes Centres at http://www.diabetessociety.com.au/nadc.asp
healthdirect at http://www.healthdirect.gov.au